Health Screening

Please complete this health screening before your high-caution service. All information is kept confidential and reviewed by our care team.

Full Name *

Mobile / WhatsApp / Line *

Email *

Preferred Language *

Service

Do you have any skin conditions, wounds, or irritations?

Do you have allergies to oils, herbs, aromas, or products?

Do you have any medical conditions?

Have you had surgery in the last 6 months?

Are you pregnant?

Current medications (if any)

Emergency contact name

Emergency contact phone

I confirm the above information is accurate and consent to this health screening being reviewed by the care team. *